A Case of Systemic Lupus Erythematosus and Antiphospholipid Syndrome Coexisting with AQP4-IgG–Negative Neuromyelitis Optica Spectrum Disorder: A Case Report and Literature Review

Systemic Lupus Erythematosus (SLE) is an autoimmune disease that primarily affects the body's connective tissues. Antiphospholipid Syndrome (APS) is another autoimmune condition, typically characterized by recurrent thrombotic events. Neuromyelitis Optica (NMO) is a rare autoimmune disorder that primarily affects the central nervous system (CNS), mainly manifesting as episodes of optic neuritis and myelitis, often resulting in vision loss and motor dysfunction. The coexistence of these three immune-related disorders is uncommon in clinical practice. This article reports a rare case of SLE complicated with APS and NMO. The patient had a 26-year history of intermittent thrombocytopenia, with a recent exacerbation for one day before admission. Clinical signs included purpura and bilateral lower limb numbness, along with a generally poor mental state. Based on clinical manifestations and laboratory investigations, the diagnosis of SLE complicated by APS and NMO was made. The patient was hospitalized multiple times. During hospitalization, immunosuppressive therapy combined with supportive treatments led to an improvement in platelet counts, though numbness in the lower limbs persisted. The patient's family declined further interventions such as intravenous immunoglobulin (IVIG) or plasma exchange and requested discharge. The concurrent onset of these three disorders can worsen the patient's condition and increase the complexity of clinical diagnosis and treatment. This paper reviews the patient's clinical data and case characteristics, as well as relevant literature, exploring the pathogenesis and possible connections among these diseases. It also highlights considerations for clinical diagnosis and treatment, aiming to provide insights and references for future clinical practice.